Healthcare Provider Details

I. General information

NPI: 1255244604
Provider Name (Legal Business Name): CARLOS ISAIAS BONILLA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 HAMILRON ST NW UNIT 117
WASHINGTON DC
20011
US

IV. Provider business mailing address

220 HAMILRON ST NW UNIT 117
WASHINGTON DC
20011
US

V. Phone/Fax

Practice location:
  • Phone: 202-840-4849
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: